ensure its complete care. - future generali · pre-acceptance medical tests pre-acceptance medical...

Ensure its complete care.

Health is wealth.

HEALTH TOTAL

A comprehensive solution to all your healthcare needs.

Paradise is where you live your life in perfect peace and harmony. However, in today’s world, your days are often mired with stress, pollution and other lifestyle hazards, the worst victim of which is your health. You may have a number of health requirements, right from regular health issues to serious ailments, leading to hospitalisation and expensive medical treatments. Although none of these are welcome, it is always good to take a health policy and be prepared for such unforeseen events. And won’t it be convenient to take just one policy against all such requirements? With Health Total, we give you a comprehensive cover, a near-perfect answer to all your medical needs.

Benefits

Hospitalisation Medical ExpensesEmergency Medical Evacuation (Applicable for Superior and Premier plan)

Daycare Treatment Expenses Domiciliary Hospitalisation Expenses

Pre-Hospitalisation Medical ExpensesOutpatient Medical Expenses (Applicable for Superior Plan and Premier Plan only)

Post-Hospitalisation Medical Expenses Child Vaccination Benefits (Applicable for Premier Plan)

Restoration of Sum InsuredNew Born Baby (Applicable for Superior and Premier Plan)

Maternity Expenses E-opinion in respect of an illness or injury

Organ Donor Expenses Alternative Treatment Cover

Patient Care Medical Treatment Abroad (Applicable for Premier Plan)

Accident Hospitalisation (Increase in Sum Insured) Wellness Care

Accompanying Person Cumulative Bonus

Road Ambulance Charges

In-house cashless settlement! Innovative covers offered! Quick settlement of claims!

Age eligibility - Cradle to Grave CoverAll plans are available with Individual and Floater option

Family Definition

Vital Plana. Self b. Spouse

c. Dependent children (Unmarried and up to the age of 25 years)

d. Dependent parents

Superior Plan and Premier Plan

a. Self b. Spousec. Dependent children (Unmarried and up to the age of 25 years)

d. Non–dependent children e. Dependent parents f. Non–dependent parents

g. Dependent siblings h. Daughter-in-law i. Son-in-law

j. Parents-in-law k. Grandparents l. Grandchildren

Minimum Policy Term 1 Year

Maximum Policy Term 3 Years

Minimum Age at Entry Day 1

Maximum Age at Entry Lifelong

Renewal Lifelong

Life Long Renewals The policy, if renewed continuously without any break, will be renewed life long.

Sum Insured Ranging from `3 lakh to `1 crore.

Co-payment Applicability In case an Insured enters the policy at the age given in the table, the respective co-payments will be applicable on each and every admissible claim.

Age Co-payment

60 years to 64 years 20%



75 years and above 40%

Pre-acceptance Medical Tests Pre-acceptance medical tests are not required for all proposers up to the age of 50 years for Vital Plan, in case of clean proposal form (i.e. without any health declaration). For age 51 years and above, medical tests are mandatory.

Compulsory medical tests are required for Superior and Premier Plans for those who completed 18 years of age and above.

*No tests required for children below 18 years for any plan. **Age in completed years

• Insured is eligible for 100% reimbursement of pre-acceptance medical tests charges, subject to policy issuance and 64 VB compliance

• Pre-acceptance medical tests need to be done at empanelled diagnostic centres only

• The tests would be considered valid for a period of one month from the date the tests have been conducted

• Underwriting loading on the standard premium rates will be applicable based on health status of the proposed Insured person. It will take into consideration the adverse health conditions declared on the proposal form and findings of medical tests conducted

• The loading of premium will be applicable on the particular Insured’s premium only

• This would be applicable for both Individual and Floater options

Eligibility

Schedule Of Benefits

Vital Plan Superior Plan Premier Plan Sum Insured (in `) 3 lakh 5 lakh 10 lakh 15 lakh 20 lakh 25 lakh 50 lakh 1 crore Minimum age at entry 1 day 1 day 1 day 1 day 1 day 1 day 1 day 1 day Maximum age at entry None None None None None None None None Maximum renewal age Lifelong Lifelong Lifelong Lifelong Lifelong Lifelong Lifelong LifelongIndividual SI / Family Floater SI options Both Both Both Both Both Both Both Both

Family definition S+Sp+2C+2P (1+5)

S+Sp+2C+2P (1+5)

S+Sp+2C+2P (1+5)

Extended family up to 15 members





HospitalisationBenefits

Hospitalisation Up to SI Up to SI Up to SI Up to SI Up to SI Up to SI Up to SI Up to SIDay care treatment √ √ √ √ √ √ √ √Pre-hospitalisation 60 days 60 days 60 days 60 days 60 days 60 days 60 days 60 days Post-hospitalisation 90 days 90 days 90 days 120 days 120 days 120 days 180 days 180 daysRestoration of SI √ √ √ √ √ √ √ √Cumulative bonus - 50% for every claim-free year to max 100%

√ √ √ √ √ √ √ √

Maternity benefit - normal delivery (in `) 15,000 20,000 25,000 30,000 40,000 40,000 50,000 50,000

Maternity benefit - LSCS (caesarian) (in `) 25,000 35,000 45,000 50,000 60,000 60,000 1,00,000 1,00,000

Vital Plan Superior Plan Premier Plan

Up to 50 years

Above 50 years

From 18 years to 50 years

Above 50 years

From 18 years to 50 years

Above 50 years

Not required Required Required Required Required Required


HospitalisationBenefits

Pre-natal hospitalisation (Within maternity limits)

× × × 90 days 90 days 90 days 90 days 90 days

Post-natal hospitalisation (Within maternity limits)

× × × 45 days 45 days 45 days 45 days 45 days

Organ donor expenses √ √ √ √ √ √ √ √

New born baby benefits: Automatic cover within mother’s / floater Sum Insured up to expiry date of policy

× × × √ √ √ √ √

New born baby benefits: Reasonable vaccination benefits up to 1 year of age (in `)

× × × Max 3,500 Max 3,500 Max 3,500 Max 5,000 Max 5,000

Patient care (Above 60 years) - per day benefit up to max (in `)

350/day 350/day 350/day 500/day 500/day 500/day 1,000/day 1,000/day

Patient care (Above 60 year) - maximum 10 days per Hospitalisation and 30 days per policy year

Accidental hospitalisation - 25% increase subject to maximum of `10 lakh

√ √ √ √ √ √ √ √

Accompanying person (Up to 12 years) `500 / day to maximum of 30 days

√ √ √ √ √ √ √ √

Domiciliary hospitalisation expenses - maximum up to 10% of SI

√ √ √ √ √ √ √ √

Alternative treatments Ayurveda / Unani / Sidha / Homeopathy - reimbursement

√ √ √ √ √ √ √ √

Medical Treatment Abroad

Medical treatment abroad

× × × × × ×

√ √

Medical treatment abroad - waiting period 4 years 4 years

Road Ambulance

Road ambulance charges - network hospitals (in `)

1,500 1,500 1,500 Actuals Actuals Actuals Actuals Actuals

Road ambulance charges - non network hospitals (Reimbursement up to a maximum) (in `)

1,500 1,500 1,500 2,000 2,000 2,000 5,000 5,000


Emergency Medical

Evacuation

Emergency medical evacuation - 5% of SI (Reimbursement up to a maximum)

× × × √ √ √ √ √

E-OpinionE-Opinion for iIlness / injury (Maximum 2 per policy year)

√ √ √ √ √ √ √ √

**Out-patient Medical Expenses

Out-patient consultations and diagnostics (Reimbursement up to a maximum (in `)

× × ×

3,000 for Individual option / 10,000 for Floater option




10,000 for Individual option / 20,000 for Floater optionPrescribed medicines

(Reimbursement up to a maximum)

× × × × × ×

Child Vaccination Benefits

Child vaccination benefits (Reimbursement up to a maximum)

× × × × × ×Up to 12 years of age (`5,000 per annum)

Up to 12 years of age (̀ 5,000 per annum)

Wellness BenefitsWellness including medical tests at designated centres

√ √ √ √ √ √ √ √

One Time Discount

One time renewal discount - subsequent to death of proposer

10% 10% 10% 10% 10% 10% 10% 10%

Family Discount Family Discount 10% (Individual SI Policies) √ √ √ √ √ √ √ √

Voluntary Deductible

Discount in lieu of voluntary deductible √ √ √ √ √ √ √ √

Waiting Periods

Pre-existing disease

Compulsory waiting period 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years

Pre-existing disease - max. liability 3rd year onwards

50% 50% 50% 50% 50% 50% 50% 50%

Pre-existing disease - 4th year onwards 100% 100% 100% 100% 100% 100% 100% 100%

General waiting periods:

30-day - fresh proposals excluding accidental hospitalisation

√ √ √ √ √ √ √ √

2-year waiting period for listed conditions √ √ √ √ √ √ √ √

4-year waiting period - joint replacement and organ transplant

√ √ √ √ √ √ √ √


Compulsory Co-pay

20% co-payment where entry age is from 60 years to 64 years

√ √ √ √ √ √ √ √


√ √ √ √ √ √ √ √


√ √ √ √ √ √ √ √

40% co-payment where entry age is 75 years and above

√ √ √ √ √ √ √ √

** Outpatient medical expenses. (Applicable for Superior and Premier Plan) In case of bills for any prescribed drugs/medicines, our liability will be restricted to 80% of admissible bills.In case of dental consultations and diagnostics, our liability will be restricted to 70% of admissible bills. * All benefits are given within the base Sum Insured except Accidental Hospitalisation.SI : Sum insured, S: Self, Sp: Spouse, C: Child, P: Parent

Exclusions 1. Charges incurred at a hospital primarily for diagnostic, X-ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any illness or injury, for which confinement is required at a hospital.

2. Cost of an annual health check-up.

3. Injury or illness directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, war like operations (Whether war is declared or not). Circumcision, unless necessary for treatment of an illness not excluded hereunder or as may be necessitated due to an accident.

4. Vaccination/inoculation (Except as post-bite treatment) except to the extent covered under Benefits 14 and 15 as mentioned in policy clause.

5. Cosmetic treatments (For change of life or cosmetic or aesthetic treatment of any description), plastic surgery other than as may be necessitated due to an accident or as a part of any illness, refractive error corrective procedures, experimental, investigational or unproven/experimental treatment, devices and pharmacological regimens of any description.

6. Charges incurred in connection with cost of spectacles and contact lenses, hearing aids, durable medical equipment (Including but not limited to cost of instrument used in the treatment of Sleep Apnea Syndrome (C.P.A.P.), Continuous Peritoneal Ambulatory Dialysis (C.P.A.D.) and oxygen concentrator for asthmatic condition, wheelchair, crutches, artificial limbs, belts, braces, stocking, Glucometer and the like), namely that equipment used externally for the human body which can withstand repeated use; is not designed to be disposable; is used to serve a medical purpose, such cost of all appliances/devices whether for diagnosis or treatment after discharge from the hospital.

7. The treatment of obesity (Including morbid obesity) and other weight control programmes, services and supplies.

8. Expenses incurred towards treatment of illness or injury arising out of alcohol use/ misuse or abuse of alcohol, narcotic substance or drugs (Whether prescribed or not).

Other Benefits 1. Subject to no claim, cumulative bonus of 50% on the basic Sum Insured will be provided up to a maximum of 100% of the Sum Insured.

2. Family discount of 10% is available in case more than one person is covered in the same policy in case of Individual Sum Insured option has been taken.

3. Long-term discount will be given in case Policy Term is more than 1 year.

Long-term discount (Applicable in case of single payment for more than 1 year)

Number of years Discount

1 year Nil

2 years 7.5%

3 years 10%

Voluntary Deductible Discount

Instalment Facility In case of policies which are on long-term basis, facility of instalment is available. Given below are the loadings applicable on standard premiums in case of instalments.

Instalment frequency Loading on

standard premiums

Monthly 5%

Quarterly 4%

Half-yearly 3%

Loading on Claim Experience There will be no loading on premium for adverse claims experience.

Tax Benefit Premium paid by any mode other than cash and demand draft is eligible for tax relief as provided under Section 80-D of the Income Tax Act.

Vital Plan Superior Plan Premiere Plan

Deductible Discounts Deductible Discounts Deductible Discounts

` 10,000 10% ` 50,000 15% ` 1,00,000 15%

` 25,000 15% ` 75,000 20% ` 2,50,000 20%

` 50,000 20% ` 1,00,000 25% ` 5,00,000 25%

Premium Table – Individual Premium Rates (Premium and Sum Insured in `)

Vital Superior Premiere

Age / Sum Insured

3,00,000 5,00,000 10,00,000 15,00,000 20,00,000 25,00,000 50,00,000 1,00,00,000

0-17 4,418 5,061 6,856 8,019 10,400 12,451 37,637 48,628

18-25 4,645 6,213 8,471 10,198 11,923 13,661 39,587 50,572

26-30 4,718 6,718 8,501 10,515 12,034 14,429 40,635 52,037

31-35 4,724 6,739 8,582 10,687 12,523 16,031 45,386 58,388

36-40 4,999 6,752 8,639 10,731 13,942 16,875 48,853 63,237

41-45 5,468 7,227 9,394 12,793 16,858 20,622 56,230 74,117

46-50 8,074 10,033 13,726 17,094 22,453 27,490 69,237 85,353

51-55 11,799 14,866 20,290 25,088 30,870 36,638 85,067 97,038

56-60 15,216 18,311 25,997 31,379 37,228 41,447 99,916 1,13,356

61-65 29,734 34,638 41,816 44,878 48,235 53,934 1,27,456 1,43,324

66-70 37,151 43,613 49,846 53,201 55,518 61,221 1,51,111 1,69,331

71-75 41,096 48,884 56,204 60,241 61,674 67,657 2,13,368 2,37,783

76-80 55,102 64,911 71,342 75,324 78,468 84,246 3,01,946 3,35,176

81-85 65,661 79,968 85,763 89,886 94,353 1,02,736 3,90,351 4,32,376

>85 67,559 81,522 87,236 91,935 1,01,603 1,16,036 4,32,241 4,78,455

*Premiums exclusive of Goods & Services Tax. **Age in completed years

Floater Discount

Applicable discount is as per following table:

Premium applicable for the primary insured will be the standard individual premiums from the premium table. For remaining dependent members, floater discounts applicable on their respective premium is as per table above.

# For example, in case of a family of self, spouse and one child, the premium for floater for Sum Insured `10,00,000 would be charged in the following manner:

Basis of claims payment a) We shall make payment in Indian Rupees and in India only.

b) In respect of surgery for cataracts (After the expiry of the two-year period referred to in Section III (1)(b) of policy clause, liability shall be restricted to 10% of the Sum Insured for each eye, and a maximum of `1,00,000 per eye.

c) If a voluntary deductible has been opted and is in force under the policy, liability would be over and above the voluntary deductible amount for each and every claim made under hospitalisation.

d) Wherever co-payments are applicable, the same would be applied on the admissible claim amount after the application of voluntary deductible, if any.

* Benefits may vary from plan to plan.

** For further details, please refer to the policy wordings.

Age Band Discount Percentage Age Band Discount Percentage

0-17 60% 56-60 35%

18-25 55% 61-65 35%

26-30 50% 66-70 35%

31-35 45% 71-75 35%

36-40 45% 76-80 25%

41-45 40% 81-85 25%

46-50 40% >85 20%

51-55 40%

Self Spouse Child

Age band 36-40 31-35 0-17

Premium as per individual rate table (in `)

8639 8582 6856

Applicable premium (in `)

8639

4720 (45% discount applied on the respective person’s premium)

2742 (60% discount applied on the respective person’s premium)

Total premium to be charged (in `) Goods & Services Tax extra

= 8639 + 4720 + 2742=16101

If you are suffering from an illness / disease or if you meet with an accident which requires hospitalisation, please contact us on the following:

Claims Department Future Generali Health (FGH) Future Generali India Insurance Co. Ltd., Office No. 3, 3rd Floor, “A” Building, G-O-Square S. No. 249 & 250, Aundh Hinjewadi Link Road, Wakad, Pune - 411 057.

Toll-Free Number: 1800 103 8889 Toll-Free Fax: 1800 103 9998 Email: [email protected]

Why choose Future Generali? Future Generali India Insurance Company Limited is a joint venture between Future Group – the game changers in Retail Trade in India and Generali – a 187 years old global insurance group featuring among the world’s 60 largest companies*. The company was incorporated in September 2007 with the objective of providing retail, commercial, personal and rural insurance solutions to individuals and corporates to help them manage and mitigate risks. Future Generali India has been aptly benefitting from the global Insurance expertise in diverse classes of products of Generali Group and the Indian retail game changers Future Group. Having firmly established its credentials in this segment and effectively leveraging on the skill set of both its JV parents, Future Generali India has evolved to become a Total Insurance Solutions Company.

*As per Fortune Global 500 Ranking (2017)

Call us at: 1800-220-233 |1860-500-3333 | 022-67837800 | Website: https://general.futuregenerali.in

Future Generali India Insurance Company Limited (IRDAI Regn. No. 132), (CIN: U66030MH2006PLC165287)

Regd. and Corp. Office: Indiabulls Finance Centre, Tower 3, 6th Floor, Senapati Bapat Marg, Elphinstone, Mumbai – 400013. Fax No: 022 4097 6900 | Email: [email protected]

ARN.: FG-NL/PD/MKTG/EN/HLTHTO-001BROUIN: IRDAI/HLT/FGII/P-H/V.1/02/15-16BAP UIN: FGIHLIP15003V011415ISO Ref. No.: FGH/UW/RET/85/02

For detailed information on the product including risk factors, terms and conditions etc., please refer to the product policy clause, consult your advisor or visit our website before concluding a sale. Trade Logo displayed above belongs to M/S Assicurazioni Generali - Societa Per Azioni and used by Future Generali India Insurance Co Ltd. under license. Future Group’s and Generali Group’s liability is restricted to the extent of their shareholding in Future Generali India Insurance Company Limited.

Health products are eligible for deduction under Section 80D of the Income Tax Act. Tax benefits are subject to change due to change in Income Tax Act.

ensure its complete care. - future generali · pre-acceptance medical tests pre-acceptance medical...

Documents